Traditional Chinese medicine is science, ma-an! National Geographic promotes quackery

Traditional Chinese is science, ma-an! No, really, TCM is science! Really and truly it is! It’s real medicine!

That’s a frequent refrain from proponents of TCM. Indeed, it’s a propaganda line that I see so frequently that, seeing the latest example of it that I’m going to discuss here, I decided to name it the “traditional Chinese medicine is science, ma-an” gambit, or maybe just the “TCM is science” gambit. Never mind that it’s not at all true. If there’s one thing TCM is not, it’s science.

As I’ve described many times before, TCM is based in ancient mysticism and vitalism. It is based on an Asian version of the dreaded ancient European concept of the four humors, except that TCM calls them the “five elements.” Just as ancient European medicine dating back at least to Hippocrates blamed disease on imbalances in the “four humors” and sought to restore that balance, TCM saw disease as an imbalance of the “five elements” (which must be better than four humors because, you know, it’s five and it’s not European). Unfortunately, thanks to Chairman Mao Zedong in the 1940s and 1950s, the entire history of TCM has been retconned and camouflaged as being science-based. It worked spectacularly, and, beginning in the 1970s, TCM has been increasingly accepted in mainstream medicine, its lack of scientific basis notwithstanding. Acupuncture and various other TCM modalities are offered in all too many academic medical centers, such as the Cleveland Clinic, which opened its own Chinese herbal medicine clinic, and UCSF, which spent $37 million to build an “integrative medicine” center that includes TCM. Meanwhile, high profile general science journals like Nature and Science think nothing of publishing advertising sections dedicated to promoting the message that TCM is science and that science-based medicine is looking to its “ancient wisdom” for medical breakthroughs. Meanwhile the World Health Organization is revamping its codes for classifying diseases to encompass TCM, while the Chinese government passes laws to promote TCM by requiring it in state hospitals and lowering the bar for its approval. Basically, TCM has become big business in China, and the Chinese government protects it against criticism. Mao’s campaign to “integrate” TCM into “Western medicine” continues apace, unfortunately, as his successors carry on his work with the help of credulous “Western” physicians.

That history is why in the January issue of National Geographic features an article by Peter Gwin entitled How ancient remedies are changing modern medicine. Its subtitle? Long overlooked by Western science, traditional Chinese treatments are yielding cutting-edge cures.

Traditional Chinese medicine is science, ma-an!

I can practically write this article myself, having seen its like so many times before. All you do is to interview a couple of pharmacologists investigating herbs of TCM origin, picking ones who think they’re on to something or might actually be on to something, don’t bother interviewing skeptics, and write a narrative about how traditional Chinese medicine is science now. I can even predict some of the examples that will be used, and I did. For instance, Gwin buys into the narrative about artemisinin, the treatment for malaria whose discoverer won the Nobel Prize:

In 1972, the year Cheng finished his Ph.D. in pharmacology at Brown University, a chemist in the People’s Republic of China named Tu Youyou announced the discovery of an antimalarial substance based on a Chinese medicinal herb mentioned in a fourth-century formula.

During the Vietnam War, Tu had been tapped to work on a secret military project to help the Vietcong combat malaria. The disease accounted for roughly half their casualties. Western health researchers were also trying to solve this problem, screening more than 200,000 compounds. But Tu wondered if an answer might lie in classical Chinese medical texts. She tested several plants related to fever and found a remedy based on a yellow-flowering herb called wormwood (Artemisia annua). The drug derived from her research, called artemisinin, has been credited with saving millions of lives and earned her the 2015 Nobel Prize for medicine.

Of course, I’ve discussed artemisinin before when Tu was awarded the Nobel Prize, as have Scott Gavura and Steve Novella. All of us noted that there was nothing special about TCM with respect to artemisinin. Nor did the awarding of the Nobel Prize to Tu in any way “validate” TCM, as its advocates claimed. After all, all Tu did was to look for compounds used in TCM for fever and ended up testing 2,000 compounds. This is nothing more than pharmacognosy, a branch of the science of pharmacology that is focused on natural products and a lot of grunt work evaluating so many compounds for activity against malaria. She then chemically modified artemisinin to dihydroartemisinin, resulting in a compound that was stable and had a ten-fold higher activity against malaria, which led to the development of other derivatives of artemisinin. Nothing about the story of artemisinin “validates” TCM. By sheer chance alone, one might expect that any traditional medicine system using herbal medicine will yield the occasional artemisinin. Herbs, after all, can contain medically useful compounds. Interestingly, some traditionalists were even sad that they were forced to admit that Tu YouYou did basically use the same methods of the dreaded “Western” medicine to turn artemisinin into a useful anti-malarial medicine.

Gwin also quotes a Yale pharmacologist named Yung-Chi Cheng, who makes an analogy to aspirin as a reason not to dismiss ancient medicine. Indeed, aspirin does predate TCM, if you mean the use of salicylate-rich plants, such as willow, in traditional medicine. References to the use of such plants appear in clay tablets from ancient Sumer and as well as the Ebers Papyrus from ancient Egypt, which referred to its use as a pain reliever, while Hippocrates used willow leaf tea to ease the pain of childbirth. The use of salicylates as pain relievers and anti-inflammatory drugs has been described ever since, up until 1897, when Bayer added an acetyl group to salicylic acid to produce aspirin. If you’re interested in learning more, here’s a cool timeline of the history of aspirin that shows that the use of plants rich in the salicylates for medicinal purposes goes back at least to 3,000 BC. However, I’d counter that aspirin is unique or very close to it. Are there other medicines so widely used whose precursors have been used continuously for thousands of years? Again, aspirin is a great drug, but it’s also very rare as an example of ancient medicine that remains so utterly useful today. No one’s saying that we shouldn’t study ancient medicines to see if they have any usefulness, but if there’s one thing I’ve noticed about boosters of TCM, it’s that they seem to view TCM as a cornucopia of undiscovered medicines that will cure cancer, heart disease, and every disease known to humans.

That’s because traditional Chinese medicine is science, ma-an!

Balance, as long as it’s false

Gwin also engages in a heapin’ helpin’ of false balance. But first, he leaves out some key facts. For instance, he mentions that ” traditional medicine remains a vibrant part of the state health care system” and that “most Chinese hospitals have a ward devoted to ancient cures.” That’s true, but that’s only part of the story. The Chinese government has been promoting TCM to one degree or other ever since Mao Zedong and, more recently, Chinese law mandates that every state medical facility offer TCM. Of course, in reality, Mao didn’t use TCM, and during the 1920s and before educated and elite Chinese viewed it as the quackery it was. Indeed, TCM 110 years ago was brutal, with acupuncture then using large lancet-like needles rather than the thin filiform needles used now, which weren’t introduced until the 1930s.

So let’s look at the false balance. First, Gwin lays down a common trope used by TCM supporters and believers:

From a research perspective, it very well may be a golden age. Scientists from leading universities in the United States and Europe, including UCLA, Duke, and Oxford, as well as many in Asia, are looking at the scientific underpinnings of some traditional treatments for diseases such as cancer, diabetes, and Parkinson’s.

Traditional Chinese medicine is science, ma-an! Funny, but scientists are also looking at the “underpinnings” of quackery that’s part of TCM like acupuncture, tongue diagnosis, and the like.

Next, he adds an appeal to popularity:

But the practice of melding the modern with the traditional is also spreading among health care consumers. When they don’t find relief from Western medicine, Americans increasingly are turning to traditional treatments, notably acupuncture, which is now covered by some health insurance plans, and cupping, a muscle therapy that involves suction and is endorsed by many professional athletes. The internet has fostered the growth in herbal remedies, which are often cheaper than doctor-prescribed pharmaceuticals. A patient can read about a traditional remedy online, order the herbs on Amazon, and watch YouTube videos on how to prepare them at home. The result is a growing alternative health sector, which in 2017 saw U.S. herbal supplement sales top eight billion dollars, a 68 percent increase since 2008.

Take that, skeptics! Traditional Chinese medicine is science, ma-an! And it’s popular, too! Checkmate, skeptics!

Speaking of skeptics, here’s how Gwin describes us:

You’ll also find doctors who denounce traditional Chinese medicine as pseudoscience and quackery, pointing to some of its most outlandish claims, like the ancient practice of prescribing firecrackers to chase away demons, or mysterious concepts still embraced, such as a nebulous life force called qi (a term translated literally as “the steam that rises from the rice”). Others rail against its use of animal parts and warn against the potential dangers of its herbal formulas.

Unfortunately, notably, Gwin appears not to have actually interviewed a single real skeptic for his article, or, if he did interview anyone, no quotes made it past the final edits. Now here comes the false balance:

“Rarely do you find anyone who looks at it objectively,” says medical historian Paul Unschuld. A leading authority on the history of Chinese medicine—and often an unsparing critic of the way it’s interpreted—he has collected and translated hundreds of ancient medical texts and is working with a Chinese-German startup to study them for ideas about treating a variety of illnesses, including epilepsy. “People generally see only what they want to see,” he says, “and fail to fully examine its merits and its faults.”

Traditional Chinese medicine is science, ma-an! That’s right, skeptics and believers are the same. They only see what they want to see, and skeptics ignore all the benefits of belief in the mystical magical qi, the torture of bears to harvest their bile, the killing of rhinos and tigers for their parts to make into useless medicines! I can’t help but note that Unschuld, as expert as he might be in Chinese history, seems to buy into the false dichotomy that doctors can be “mechanics” or “intellectuals.” Guess which category “Western medicine” practitioners fall into compared to TCM practitioners. On second thought, not exactly:

The intellectual healer follows a different course. He wants to know why biomedicine has arrived at its current notions of the origin and nature of disease, and at therapeutic interventions derived from them. He wants to know what the essential difference is between different health care traditions, and he wishes to have arguments (and be able to voice these arguments) as to why he prefers one approach over another. The intellectual healer may realize that one type of health care is good for a certain portion of his clientele, while the mental set-up of another portion of his clientele requires a different therapeutic approach.

In other words, it’s the “integrative medicine” practitioner, who’s willing to draw from “both worlds,” who’s the true “intellectual healer,” not the “Western doctor” or the TCM practitioner. No wonder Gwin interviewed Unschuld!

Here’s some more false balance. Gwin references a story he did about rhinocerous poaching. Rhino poaching is a huge problem. Poachers kill them for their horns because rhino horn is used in TCM to treat a wide variety of ailments. Gwin noted that such extracts, which are mostly keratin, produce little or no physiologic effect but could work through the placebo effect. (That’s a whole other can of worms, namely the misunderstanding of placebo effects.) He then reports that he got letters from readers “angrily denouncing Chinese medicine as ‘ignorant,’ ‘cruel,’ and akin to ‘witchcraft,'” which it, in fact, is. Now here’s a doozy of a bit of false balance:

Such criticisms aren’t without merit. Rhino horn sales in Asia are a primary factor pushing rhino populations toward extinction. In addition to bears, many other animals—including several threatened species such as tigers, leopards, and elephants—are poached in the wild or farmed for their parts.

But modern medicine has its own controversial practices. The effectiveness of many popular antidepressant drugs remains hotly debated, with some studies showing they are barely more effective than placebos. Yet these drugs are extensively marketed and widely prescribed by physicians, generating billions of dollars in revenue. (This isn’t to say depression drugs don’t work. If a patient’s symptoms are relieved, then one can argue they work. But the chemicals in the pills themselves may not always be the source of the relief, just like the chemicals in rhino horn aren’t necessarily the source of relief for patients who take it.) When considered alongside other notable examples—the overprescription of opioids, doctor-endorsed fad diets, and questionable surgeries—Western indignation over traditional Chinese medicine can seem more hypocritical than Hippocratic.

Traditional Chinese medicine is science, ma-an, and science-based medicine boosters are a bit of hypocrites! TCM is the cause of the wanton killing of endangered species for their parts, which are mixed into various potions, as well as the torture of Asian bears to harvest their bile, but damn if “Western medicine” doesn’t have its own “questionable” practices!

There’s only one response to this, and it comes to us courtesy of Godzilla:

William Cole gets a Godzilla facepalm

So. Much. False. Balance.

So. Much. Misunderstanding. Of. Placebo. Effects.

Alternatively, in response I like to quote Ben Goldacre:

Yes, science-based medicine has some questionable practices. However, many of these problematic practices are due not to its science but rather due to an inadequately rigorous application of science. The answer, therefore, is more rigorous science, not to embrace magic. Again, just because “conventional medicine” has problems does not mean that magic works! It does not mean that a system of medicine based on mysticism, vitalism, and prescientific beliefs is superior—or even equivalent. It does not mean that we should take prescientific mysticism, much of which is actually well demonstrated in a beautiful and elaborate infographic of TCM concepts and practices included in the article, complete with balancing the “four proporties” and the “five flavors” in herbal remedies. Yet Gwin credulously regurgitates that false dichotomy. Epic fail!

Let’s put it this way. In the article, there is a photo of a TCM practitioner setting a patient’s back on fire. (The patient is completely covered in a blanket.) Its caption reads:

In a fire treatment session in Chengdu, an alcohol-soaked cloth is draped over a patient and set alight to warm the skin and open the pores; an herb-infused oil is then applied. The therapy aims to treat joint pain and other ailments, but research has yet to prove such claims.

I hope there’s a burn unit in Chengdu. Also, wouldn’t a large heating pad achieve the same end with far less chance of causing significant burns? The TCM practitioner could even control the temperature! I am, however, amused by the part about how “research has yet to prove such claims.” Ya think?

Traditional Chinese medicine is science, ma-an! Really, ma-an!

There are a couple of other examples, besides that of artemisininm, that Gwin appears impressed by. The first is a combination of multiple TCM herbs based on an 1,800-year-old recipe for a mixture of skullcap, licorice, peony, and Chinese date, described as a treatment for “diarrhea, abdominal pain, and scorching heat in the anus.” It’s designated PHY906 and was touted as good for alleviating the symptoms due to chemotherapy side effects. PHY906 is a powder containing a spray-dried aqueous extract derived from the Huang Qin Tang formula. It consists of four principal herbs (Figure 1): Glycyrrhiza uralensis Fisch, Paeonia lactiflora Pall, Scutellaria baicalensis Georgi, and Ziziphus jujuba Mill.

Me being me, naturally I couldn’t resist searching PubMed for PHY906. When I did, I found that the earliest publication dates back to 2003, which means that this compound has been in development for at least 15 years. Yet, one thing I didn’t find was a decent-sized randomized phase III clinical trial of the compound. A recent summary of the evidence for PHY906 reveals a compound that might be useful to combine with the chemotherapy agent irinotecan for some cancers and could potentially alleviate some GI symptoms of chemotherapy-induced toxicity, but nothing special. You wouldn’t know that from the writeup by Gwin, which makes PHY906 sound like an incredibly promising new agent based on ancient wisdom. In reality as I see it perusing the evidence, PHY906 looks like a somewhat promising agent that could be useful when added to conventional chemotherapy. Time will tell, although you’ll be forgiven if, reading Gwin’s article, you’re left with the impression that PHY906 will cure all cancers, as Gwin goes to the fields in China where the herbs are harvested and marvels at them.

Finally, perhaps the most offensive part of Gwin’s article is how it seems to go out of its way to justify the use of bear bile in TCM. The harvesting of bear bile is truly a barbaric practice. Bears are confined in tiny cages, with catheters implanted in their gallbladders to harvest the bile. That doesn’t stop Gwin from lionizing Paul Iaizzo, head of the University of Minnesota’s Visible Heart Lab, who’s been studying bear bile as a means of keeping hearts viable longer for transplant. Apparently, Iaizzo has produced evidence that certain chemicals from bear bile can prolong the viability of hearts harvested for transplant.

Particularly egregious is this passage:

I ask him whether the Chinese practice of drinking bear bile could really bestow any health benefits. “It could,” Iaizzo says, noting the chemicals would enter the bloodstream and move through the heart and other organs. He doesn’t condone farming bears for their bile, emphasizing that the chemicals can be synthesized, but the science is the science. And though the ancient Chinese didn’t understand how bear bile helped humans, they observed that it did.

Did they, though? I would question that assertion. Identifying effects on survival and symptoms due to cardiovascular disease requires rigorous clinical methodology and randomized clinical trials. It is doubtful that anecdotal observations from hundreds or thousands of years ago would identify a clinically meaningful benefit. Yes, the chemicals from bear bile can be synthesized, but the whole passage struck me as at least partially justifying the use of bear bile as medicine. You think I’m being too harsh? I don’t think so. Look at this passage concluding the article:

As I hold the pig heart, I can feel its rhythm slowing. It finally stops. The pig died hours ago, and now its heart has stopped too. Its color seems to dim—like a mahi-mahi that loses its lightning yellow glow as it dies in the hands of a fisherman. I wonder if whatever is now gone is what the ancient Chinese meant by qi.

I think of the moment in the hospital when I was holding my father’s hand and felt his pulse finally stop. I’m suddenly aware of my own heart, flexing and lurching inside my rib cage, and wonder about its other mysteries.

Dammit. Traditional Chinese medicine is science, ma-an! Except that it isn’t. I groaned as I read the conclusion of this article. I’m sorry that Gwin’s father died, but qi doesn’t exist. The five elements don’t exist, not in the way TCM claims they do. Acupuncture doesn’t work. A few TCM herbal remedies might work, but that doesn’t justify TCM. Again, I find it particularly telling the Gwin didn’t bother to interview a single skeptic. It’s almost as though he’s a believer in TCM himself.

No matter how much advocates try to claim that TCM is science, ma-an, it’s not. Unfortunately National Geographic has jumped on the TCM propaganda bandwagon to promote its prescientific, pseudoscientific, and mystical nonsense.